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Items 1 - 47 of 47 |
One page. |
Comment on:
Are preemptive analgesic effects of ketamine linked to inadequate perioperative analgesia?
Van Elstraete AC, Lebrun T, Sandefo I, Polin B.
Publication Types:
PMID: 15502071 [PubMed - indexed for MEDLINE]
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Intraoperative wake-up test and postoperative emergence in patients undergoing spinal surgery: a comparison of intravenous and inhaled anesthetic techniques using short-acting anesthetics.
Grottke O, Dietrich PJ, Wiegels S, Wappler F.
Department of Anesthesiology, University Witten/Herdecke, Hospital Cologne-Merheim, Ostemerheimer Strassse 200, D-51109 Cologne, Germany.
Surgical procedures on the vertebral column may result in spinal cord damage, leading to neurological deficits that demand immediate therapeutical intervention. We designed this study to determine which anesthetic regimen allows a rapid wake-up test during and after surgery to detect neurological deficits. Fifty-four patients were randomly allocated to the following groups: group PR (propofol/remifentanil): target-controlled infusion with propofol (plasma concentration, 2-4 microg/mL) and remifentanil 0.2-0.5 microg . kg(-1) . min(-1); group PS (propofol/sufentanil): propofol (2-4 microg/mL) and repetitive boluses of 0.1-0.2 microg/kg of sufentanil adjusted to patients requirements; and group DR (desflurane/remifentanil): desflurane/air 3.0-4.0 vol% combined with remifentanil 0.2-0.5 microg . kg(-1) . min(-1). Group PS required significantly longer times for the onset of breathing (8.9 +/- 1.6 min), elevation of the head (17.0 +/- 3.8 min), and motion of the feet (17.0 +/- 7.4 min) than group PR (6.9 +/- 2.6 min, 9.3 +/- 2.2 min, and 9.4 +/- 2.4 min, respectively) or group DR (5.4 +/- 0.8 min, 6.1 +/- 1.0 min, and 6.2 +/- 1.0 min, respectively). The anesthetic regimen with desflurane and remifentanil allowed faster awakening during and after surgery that permitted immediate neurological examination after spinal surgery compared with propofol/remifentanil.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15502058 [PubMed - indexed for MEDLINE]
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Preincisional intravenous pentoxifylline attenuating perioperative cytokine response, reducing morphine consumption, and improving recovery of bowel function in patients undergoing colorectal cancer surgery.
Lu CH, Chao PC, Borel CO, Yang CP, Yeh CC, Wong CS, Wu CT.
Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, National Defense University, #325 Section 2 Chenggung Road, Neihu 114, Taipei, Taiwan, Republic of China.
Cytokine release during surgery can produce a long-lasting hyperalgesia. Thus, preoperatively-administered cytokine inhibitors might reduce the production of cytokines, decreasing central nervous system sensitization and improving the quality of postoperative pain relief. We investigated the hypothesis that preincisional IV pentoxifylline (PTX) treatment could attenuate the release of proinflammatory (tumor necrosis factor, interleukin (IL)-1beta, IL-6, and IL-8) and antiinflammatory (IL-1 receptor antagonist) cytokines in patients who underwent elective colorectal cancer surgery. Forty patients were randomly assigned to 1 of 2 groups of 20 each: the PTX group received a PTX 5 mg/kg IV infusion before the induction of anesthesia, whereas the control group received an equal volume of normal saline. Venous blood samples were obtained at frequent intervals. After surgery, all patients received patient-controlled analgesia (PCA) morphine for postoperative pain relief. Patients in the PTX group exhibited longer PCA trigger times, less morphine consumption, and a faster return of bowel function compared with patients in the control group. Moreover, the plasma levels of IL-6, IL-8, and IL-1 receptor antagonist were less in the treatment group, and there was no significant difference in wound infections, tumor recurrence, or metastatic rates between groups during a 2-yr follow-up.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15502050 [PubMed - indexed for MEDLINE]
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The postoperative analgesic effect of tramadol when used as subcutaneous local anesthetic.
Altunkaya H, Ozer Y, Kargi E, Ozkocak I, Hosnuter M, Demirel CB, Babuccu O.
Department of Anesthesiology, Zonguldak Karaelmas University, School of Medicine, Ev-Ko Konutlari F-66 No: 8, 67600 Kozlu/Zonguldak, Turkey. haltunkaya@hotmail.com
Recently, it has been shown that tramadol was an effective local anesthetic in minor surgery. In this study, its efficacy for relieving postoperative pain was evaluated. Forty patients undergoing minor surgery (lipoma excision and scar revision) under local anesthesia were included. The patients were randomly allocated into two groups: In group T (n = 20), 2 mg/kg tramadol, and in group L (n = 20), 1 mg/kg lidocaine were given subcutaneously. In both groups, the injection volume was 5 mL containing 1/200,000 adrenalin. The degree of the erythema, burning sensation, and pain at the injection site were recorded. Incision response, which is a degree of the pain sensation during incision, was recorded and graded with the visual analog scale (VAS) 0-10. After incision, VAS values were recorded at 15-min intervals. When the VAS score of the pain during surgery exceeded 4, an additional 0.5 mg/kg of the study drug was injected and this dosage was added to the total amount. Patients were discharged on the same day. Subjects with VAS > or =4 were advised to take paracetamol as needed. No side effects were recorded in either group except for 1 patient complaining of nausea in group T at the 30th min of operation. After 24 h, patients were called and the time of first analgesic use and total analgesic dose taken during the postoperative period were recorded. During the 24 postoperative hours, 18 of 20 (90%) subjects did not need any type of analgesia in group T, whereas this number was 10 (50%) in group L (P < 0.05). The time span before taking first analgesic medication was longer (4.9 +/- 0.3 h) in group T than that of group L (4.4 +/- 0.7 h) (P < 0.05). We propose that tramadol can be used as an alternative drug to lidocaine for minor surgeries because of its ability to decrease the demand for postoperative analgesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15502049 [PubMed - indexed for MEDLINE]
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S(+)-ketamine as an analgesic adjunct reduces opioid consumption after cardiac surgery.
Lahtinen P, Kokki H, Hakala T, Hynynen M.
Department of Anesthesiology and Intensive Care, Kuopio University Hospital, FIN-70210 Kuopio, Finland. pasi.lahtinen@kuh.fi
There are no studies evaluating S(+)-ketamine for pain management after sternotomy. In this prospective, randomized, double-blind, placebo-controlled clinical trial, we evaluated the efficacy and feasibility of S(+)-ketamine as an adjunctive analgesic after cardiac surgery. Ninety patients scheduled for elective coronary artery bypass grafting (CABG) were randomized to receive either a 75 microg/kg bolus of S(+)-ketamine followed by a continuous infusion of 1.25 microg . kg(-1) . min(-1) for 48 h (n = 44) or placebo (normal saline bolus and infusion) (n = 46). From the time of tracheal extubation, patients could access an opioid (oxycodone) via a patient-controlled analgesia device, and the cumulative oxycodone doses were measured over 48 h. Pain was evaluated on a visual analog scale three times daily. The quality of recovery, patient satisfaction with pain management, and adverse effects were recorded. The cumulative oxycodone consumption during the first 48 postoperative hours was less in the S(+)-ketamine group (103 +/- 44 mg) than in the placebo group (125 +/- 45 mg; mean difference, 22 mg; 95% confidence interval for the difference, 3-40 mg; P = 0.023). Pain scores did not differ between the groups at rest (P = 0.17) or during a deep breath (P = 0.23). Patient satisfaction was superior in S(+)-ketamine-treated patients: 26 (60%) of 44 in the S(+)-ketamine group compared with 16 (35%) of 46 in the placebo group were very satisfied with the analgesic management (P = 0.032). Nausea and vomiting were the most common adverse events, with similar frequencies in both groups. Four patients in the S(+)-ketamine group developed transient hallucinations during the infusion, versus none in the placebo group. In conclusion, small-dose S(+)-ketamine decreased opioid consumption in CABG patients during the first 48 h after surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15502020 [PubMed - indexed for MEDLINE]
Perioperative compartment syndrome of the hand.
Kies SJ, Danielson DR, Dennison DG, Warner ME, Warner MA.
Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Publication Types:
PMID: 15505463 [PubMed - indexed for MEDLINE]
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Comment on:
Physiotherapy compared with advice for low back pain: targeting "physical factors" alone is not evidence based practice.
Simmonds M, Daykin A.
Publication Types:
PMID: 15591573 [PubMed - indexed for MEDLINE]
Comment on:
Physiotherapy compared with advice for low back pain: study supports concept of self management of pain...
Doherty D.
Publication Types:
PMID: 15591572 [PubMed - indexed for MEDLINE]
Comment on:
Physiotherapy compared with advice for low back pain: ...but at no point compared physiotherapy with chiropractic.
Bartley R.
Publication Types:
PMID: 15591571 [PubMed - indexed for MEDLINE]
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Troponin in patients with chest pain.
Curzen N.
Publication Types:
PMID: 15591542 [PubMed - indexed for MEDLINE]
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Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial.
Vas J, Mendez C, Perea-Milla E, Vega E, Panadero MD, Leon JM, Borge MA, Gaspar O, Sanchez-Rodriguez F, Aguilar I, Jurado R.
Pain Treatment Unit, Centro de Salud Dos Hermanas A (Distrito Sanitario Sevilla-Sur), 41700 Dos Hermanas, Spain. jvas@acmas.com
OBJECTIVES: To analyse the efficacy of acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee, with respect to pain relief, reduction of stiffness, and increased physical function during treatment; modifications in the consumption of diclofenac during treatment; and changes in the patient's quality of life. DESIGN: Randomised, controlled, single blind trial, with blinded evaluation and statistical analysis of results. SETTING: Pain management unit in a public primary care centre in southern Spain, over a period of two years. PARTICIPANTS: 97 outpatients presenting with osteoarthritis of the knee. INTERVENTIONS: Patients were randomly separated into two groups, one receiving acupuncture plus diclofenac (n = 48) and the other placebo acupuncture plus diclofenac (n = 49). MAIN OUTCOME MEASURES: The clinical variables examined included intensity of pain as measured by a visual analogue scale; pain, stiffness, and physical function subscales of the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index; dosage of diclofenac taken during treatment; and the profile of quality of life in the chronically ill (PQLC) instrument, evaluated before and after the treatment programme. RESULTS: 88 patients completed the trial. In the intention to treat analysis, the WOMAC index presented a greater reduction in the intervention group than in the control group (mean difference 23.9, 95% confidence interval 15.0 to 32.8) The reduction was greater in the subscale of functional activity. The same result was observed in the pain visual analogue scale, with a reduction of 26.6 (18.5 to 34.8). The PQLC results indicate that acupuncture treatment produces significant changes in physical capability (P = 0.021) and psychological functioning (P = 0.046). Three patients reported bruising after the acupuncture sessions. CONCLUSIONS: Acupuncture plus diclofenac is more effective than placebo acupuncture plus diclofenac for the symptomatic treatment of osteoarthritis of the knee.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15494348 [PubMed - indexed for MEDLINE]
Editorial III: Nociceptin/orphanin FQ peptide-receptor system: are we any nearer the clinic?
Barnes TA, Lambert DG.
Publication Types:
PMID: 15472142 [PubMed - indexed for MEDLINE]
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Small dose of clonidine mixed with low-dose ropivacaine and fentanyl for epidural analgesia after total knee arthroplasty.
Forster JG, Rosenberg PH.
Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, PB 340, FIN-00029 Helsinki, Finland. johannes.forster@hus.fi
BACKGROUND: We studied whether a small dose of clonidine added to a ropivacaine-fentanyl mixture improves epidural analgesia without provoking side effects typically related to larger amounts of epidural clonidine. METHODS: In this randomized, double-blinded study, patients (< or =85 yr, ASA I-III) underwent total knee arthroplasty (TKA) performed under spinal anaesthesia. After the operation, patients received an epidural infusion consisting of ropivacaine 2 mg ml(-1) and fentanyl 5 microg ml(-1) either without (Group RF, n=33) or with clonidine 2 microg ml(-1) (Group RFC, n=36). The infusion rate was adjusted within the range 3-7 ml h(-1). RESULTS: Average rate of infusion was slightly smaller in Group RFC than in Group RF (mean (sd) 4.7 (0.72) vs 5.2 (0.8) ml h(-1), P=0.004). Compared with the RF group, patients in the RFC group required significantly less rescue pain medication, that is i.m. oxycodone (median (25th, 75th percentile) 0 (0, 7) vs 7 (0, 12) mg, P=0.027). Arterial pressure and heart rate were slightly lower in Group RFC throughout the study period (mean difference between the groups 5 mm Hg (P<0.002) and 3 min(-1) (P=0.12), respectively). The groups did not differ statistically with respect to nausea, motor block, and sedation. CONCLUSIONS: The small amount of clonidine added to the low-dose ropivacaine-fentanyl mixture reduced the need for opioid rescue pain medication after TKA. Clonidine slightly decreased arterial pressure and heart rate without jeopardizing haemodynamics. Otherwise, the side effect profiles were comparable in both groups.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15377579 [PubMed - indexed for MEDLINE]
-
Spread of subarachnoid block, intraoperative local anaesthetic requirements and postoperative analgesic requirements in Caesarean section and total abdominal hysterectomy.
Fassoulaki A, Gatzou V, Petropoulos G, Siafaka I.
Department of Anaesthesiology, Aretaieion Hospital, Medical School, University of Athens, 76 Vassilissis Sofias Avenue, Athens 11528, Greece. afassou1@otenet.gr
BACKGROUND: Pregnancy is associated with a higher spread of subarachnoid anaesthesia and increased pain threshold. The study was designed to assess the spread of subarachnoid block and the intra- and postoperative analgesic requirements in pregnant vs non-pregnant women. METHODS: We assessed the level of subarachnoid anaesthesia after 1.8 ml of hyperbaric lidocaine 5% and the postoperative analgesic requirements in women undergoing Caesarean section and undergoing abdominal hysterectomy (30 each group). Intraoperatively epidural ropivacaine was given as required. All patients received 10 ml of ropivacaine 0.2% epidurally 2, 10, and 24 h after operation and the VAS pain score was assessed. They also had access to patient controlled analgesia i.v. morphine. RESULTS: Duration of surgery was 64 (13.7) vs 127 (33.8) min (P<0.0001) in the pregnant and non-pregnant groups. Ten minutes after subarachnoid injection, sensory block was higher by three dermatomes in the pregnant group (P<0.0001). Time to first ropivacaine dose was 37 (19.7) vs 19 (12.2) min (P<0.001) and the ropivacaine normalized for the duration of anaesthesia was 0.8 (0.6) vs 1.3 (0.5) mg(-1) (P=0.001) in the pregnant and non-pregnant groups, respectively. The time between the first and second ropivacaine dose was similar in the two groups (P=0.070). Fewer pregnant women (81 vs 100%) required ropivacaine intraoperatively (P=0.017). The VAS scores were similar but parturients consumed more i.v. morphine (33 (14) vs 24 (12) mg, P=0.016) during the first 24 h after operation. CONCLUSIONS: Pregnant patients exhibited a higher level of subarachnoid sensory block and required more i.v. morphine after operation.
PMID: 15347609 [PubMed - indexed for MEDLINE]
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Randomized double-blind clinical trial comparing topical and sub-Tenon's anaesthesia in routine cataract surgery.
Srinivasan S, Fern AI, Selvaraj S, Hasan S.
Department of Ophthalmology, Hairmyres Hospital, Lanarkshire Acute Hospitals NHS Trust, Lanarkshire, Scotland, UK.
BACKGROUND: Several local anaesthetic techniques are available for cataract surgery. Recently, topical anaesthesia has gained in popularity. A randomized trial was designed to compare patient discomfort and intraoperative complications following routine cataract surgery under topical or sub-Tenon's anaesthesia. METHODS: A randomized double-blinded placebo-controlled clinical trial of 210 patients assigned to either a sub-Tenon's group (sub-Tenon's anaesthesia with placebo topical balanced salt solution, n=140) or a topical anaesthesia group (topical anaesthesia with placebo sub-Tenon's injection of balanced salt solution, n=70) was carried out. All patients underwent phacoemulsification with intraocular lens implantation. Patients in the sub-Tenon's group received a single injection (3 ml) of a combination of lidocaine 2% (2 ml) and bupivacaine 0.75% (1 ml), and four doses of topical placebo (balanced salt solution). Patients in the topical anaesthesia group received four doses of topical proxymethocaine 0.5% and a placebo sub-Tenon's injection (3 ml) of balanced salt solution. No intracameral injection of local anaesthetic was given. A 10-point visual analogue pain scale was used preoperatively and for postoperative pain assessment immediately after the operation and 30 min postoperatively. The intraoperative complications in the two groups were recorded. RESULTS: The mean pain score immediately after surgery was 2.42 (sd 2.2) in the sub-Tenon's group and 3.44 (2.3) in the topical anaesthesia group (P=0.0043). The mean pain score 30 min after surgery was 1.24 (1.7) in the sub-Tenon's group and 2.25 (2.2) in the topical anaesthesia group (P=0.0009). CONCLUSIONS: Patients undergoing cataract surgery under topical anaesthesia experience more postoperative discomfort than patients receiving sub-Tenon's anaesthesia. Surgery-related complications were similar in both groups.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15321935 [PubMed - indexed for MEDLINE]
Occipital nerve block rapidly eliminates allodynia far from the site of headache: a case report.
Young WB, Mateos V, Ashkenazi A.
Department of Neurology, Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia 19107, USA. william.b.young@jefferson.edu
Publication Types:
PMID: 15377325 [PubMed - indexed for MEDLINE]
-
Is the Effect of Inguinal Field Block With 0.5% Bupivacaine on Postoperative Pain After Hernia Repair Enhanced by Addition of Ketorolac or S(+) Ketamine?
Clerc S, Vuilleumier H, Frascarolo P, Spahn DR, Gardaz JP.
From the *Department of Anesthesiology, University Hospital, Lausanne, Switzerland; and daggerDepartment of Surgery, University Hospital, Lausanne, Switzerland.
OBJECTIVE:: The aim of the study was to assess whether coadministration of S(+) ketamine or ketorolac would enhance or prolong local analgesic effect of bupivacaine after inguinal hernia repair. DESIGN:: Prospective double-blind randomized study evaluating pain intensity after surgery under general anesthesia. SETTING:: Outpatient facilities of the University Hospital of Lausanne. PATIENT:: Thirty-six ASA I-II outpatients scheduled for elective day-case inguinal herniorraphy. INTERVENTION:: Analgesia strategy consisted of a wound infiltration and an inguinal field block either with 30 mL bupivacaine (0.5%) or with the same volume of a mixture of 27 mL bupivacaine (0.5%) + 3 mL S(+) ketamine (75 mg) or a 28 mL bupivacaine (0.5%) + 2 mL ketorolac (60 mg). Postoperative analgesic regimen was standardized. OUTCOME MEASURES:: Pain intensity was assessed with a Visual Analog Scale, a verbal rating score, and by pressure algometry 2, 4, 6, 24, and 48 hours after surgery. RESULTS:: The 3 groups of patients experienced the highest Visual Analog Scale pain score at 24 hours, which was different from those at 6 and 48 hours (P < 0.05). Apart from a significantly lower pain sensation (verbal rating score) in the ketorolac group at 24 and 48 hours and only at 48 hours with ketamine, there were no other differences in pain scores, pain pressure thresholds, or rescue analgesic consumption between groups throughout the 48-hour study period. CONCLUSION:: The addition of S (+)-ketamine or ketorolac only minimally improves the analgesic effect of bupivacaine. This may be related to the tension-free hernia repair technique associated with low postoperative pain.
PMID: 15599137 [PubMed - as supplied by publisher]
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The Utility of Somatic Items in the Assessment of Depression in Patients With Chronic Pain: A Comparison of the Zung Self-Rating Depression Scale and the Depression Anxiety Stress Scales in Chronic Pain and Clinical and Community Samples.
Taylor R, Lovibond PF, Nicholas MK, Cayley C, Wilson PH.
From the *School of Psychology, University of New South Wales, Sydney, Australia; daggerPain Management and Research Centre, Royal North Shore Hospital, University of Sydney, St. Leonards, Australia; double daggerSchool of Psychology, Flinders University of South Australia, Adelaide, Australia; and section signSchool of Psychology, Southern Cross University, Coffs Harbour, Australia.
OBJECTIVE:: To investigate the role of somatic items in the assessment of depression in chronic pain. METHODS:: The Self-Rating Depression Scale was administered to 398 individuals with chronic pain, 313 psychology clinic patients with similar overall levels of depression, and a general population sample of 491. All three samples were also administered the Depression Anxiety Stress Scales. RESULTS:: Confirmatory factor analysis of pooled Self-Rating Depression Scale and Depression Anxiety Stress Scales items revealed that Self-Rating Depression Scale items denoting diurnal variation, decreased appetite, weight loss and constipation failed to contribute to depression in all 3 samples. Items denoting tachycardia and irritability also failed to discriminate between depression and a combined anxiety/stress factor in all 3 samples. The chronic pain sample endorsed somatic items, in particular psychomotor retardation, sleep disturbance, constipation, and fatigue, more strongly than the other samples relative to their endorsement of nonsomatic depression items. CONCLUSIONS:: It was concluded that depression measures that give emphasis to somatic symptoms provide poor measures of depression severity in any individuals and in patients with chronic pain may lead to an overestimation of the severity of depression. More recently developed instruments avoid these limitations and are also better able to discriminate depression from related states such as anxiety and tension/stress.
PMID: 15599136 [PubMed - as supplied by publisher]
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Catastrophizing: A Risk Factor For Postsurgical Pain.
Pavlin DJ, Sullivan MJ, Freund PR, Roesen K.
From the *Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington; and daggerDepartment of Psychology, University of Montreal, Montreal, Quebec, Canada.
OBJECTIVE:: This research was designed to test the hypothesis that presurgery "catastrophizing" would predict postsurgical pain and postsurgical analgesic consumption. METHODS:: A sample of 48 individuals who underwent anterior cruciate ligament repair participated in the study. All participants completed the Pain Catastrophizing Scale (described by Sullivan et al in 1995) prior to surgery. Measures of pain (pain scores on a scale of 0-10) were obtained in the postanesthetic care unit, as well as 1, 2, and 7 days after surgery. Opioid and nonopioid analgesic consumption was tabulated while patients were in the hospital and after discharge. RESULTS:: Results showed that the Pain Catastrophizing Scale was a significant predictor of acute postsurgical pain in the postanesthetic care unit (r = 0.48, P = 0.004 for maximum pain in the postanesthetic care unit). Maximum pain ratings in patients with high Pain Catastrophizing Scale scores (> median of 13) were 33% to 74% higher numerically than in patients with low Pain Catastrophizing Scale scores (</= median), and the duration of moderate-severe pain (>3/10) was more prolonged (45 minutes versus 28 minutes in patients with high and low Pain Catastrophizing Scale scores, respectively; P < 0.05). The Pain Catastrophizing Scale was also predictive of pain with activity at 24 hours (r = 0.65 for pain on walking, P </= 0.0001). The Pain Catastrophizing Scale did not predict postoperative analgesic use. CONCLUSION:: The pattern of findings suggests that high catastrophizing scores may be a risk factor for heightened pain following surgery. Clinical and theoretical implications of the findings are addressed.
PMID: 15599135 [PubMed - as supplied by publisher]
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Test-Retest Reliability of the Short-Form McGill Pain Questionnaire: Assessment of Intraclass Correlation Coefficients and Limits of Agreement in Patients With Osteoarthritis.
Grafton KV, Foster NE, Wright CC.
From the *School of Health and Social Care, Sheffield Hallam University, Sheffield, United Kingdom; daggerDepartment of Physiotherapy Studies and Primary Care Sciences Research Centre, Keele University, Staffordshire, United Kingdom; and double daggerSchool of Health and Social Sciences, Coventry University, Coventry, United Kingdom.
OBJECTIVES:: No previous study has adequately demonstrated the test-retest reliability of the Short-Form McGill Pain Questionnaire, yet it is increasingly being used as a measure of pain. This study evaluates the test-retest reliability in patients with osteoarthritis. METHODS:: A prospective, observational cohort study was undertaken using serial evaluation of 57 patients at 2 time points. A sample of patients awaiting primary hip or knee joint replacement surgery were recruited in clinic or via mail (mean age 64.8 years). Short-Form McGill Pain Questionnaires were delivered by mail 5 days apart, and a supplementary questionnaire was completed on the second occasion to explore if the patients' pain report had remained stable. RESULTS:: The intraclass correlation coefficient was used as an estimate of reliability. For the total, sensory, affective, and average pain scores, high intra-class correlations were demonstrated (0.96, 0.95, 0.88, and 0.89, respectively). The current pain component demonstrated a lower intraclass correlation of 0.75. The coefficient of repeatability was calculated as an estimation of the minimum metrically detectable change. The coefficients of repeatability for the total, sensory, affective, average, and current pain components were 5.2, 4.5, 2.8, 1.4 cm, and 1.4, respectively. DISCUSSION:: Problems of adequate completion of the Short-Form McGill Pain Questionnaire were highlighted in this sample, and supervision via telephone contact was required. Patients recruited in clinic who had practiced completing the Short-Form McGill Pain Questionnaire demonstrated fewer errors than those recruited by mail. The Short-Form McGill Pain Questionnaire was demonstrated to be a highly reliable measure of pain. These results should not be generalized to a more elderly population, as increasing age was correlated with greater variability of the sensory component scores.
PMID: 15599134 [PubMed - as supplied by publisher]
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Customization of Pain Treatments: Single-Case Design and Analysis.
Onghena P, Edgington ES.
From the *Department of Educational Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; and daggerDepartment of Psychology, University of Calgary, Calgary, Canada.
The aim of this paper is to acquaint pain researchers and practitioners with recent developments in the single-case experimental approach and their potential to allow for tailoring the treatment and its evaluation to the specific complaints, aptitudes, or profile of the individual patient, without violating the canons of good science and practice. After contrasting the single-case experimental approach and the case-study approach, we show the possibilities of customization in design, measurement, and test statistics. This is done by distinguishing 2 types of single-case designs-alternation designs and phase designs-and 2 types of replication strategies-simultaneous replications and sequential replications. In addition, tailor-made randomization tests are proposed for alternation, phase, and simultaneous replication designs and the combining of P values to perform a meta-analysis on designs that are sequentially replicated. With our emphasis on: 1) randomization in the design; 2) the possibilities for a statistical test (together with the determination of power and the calculation of effect sizes); 3) the importance of reliable and valid measurement; and 4) the role of replication, we demonstrate how internal validity, statistical-conclusion validity, construct validity, and external validity concerns can be dealt with within a single-case experimental approach framework. Finally, the many research examples and references to clinical work illustrate the usefulness of the approach.
PMID: 15599132 [PubMed - as supplied by publisher]
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The potential of treatment matching for subgroups of patients with chronic pain: lumping versus splitting.
Turk DC.
From the Department of Anesthesiology, University of Washington, Seattle, WA.
A large and diverse number of treatments have been shown to be effective in reducing pain and other symptoms for a minority but statistically significant number of patients in different chronic pain syndromes. The means by which such different treatments achieve similar outcomes is not well understood. In this paper, the importance of considering patient heterogeneity for those who may be diagnosed with the same medical syndrome is discussed. The author suggests that the lack of satisfactory treatment outcomes for the treatments of chronic pain syndromes may be accounted for by the patient homogeneity myth-the assumption that all patients with the same medical diagnosis are similar on all important variables. The importance of subdividing (splitting) patients into meaningful groups is described. Studies presenting data on the identification of patient subgroups based on psychosocial and behavioral characteristics and the reliability and validity of this approach are presented. Some initial attempts to demonstrate the potential for matching treatments to patient subgroups are described.
PMID: 15599131 [PubMed - in process]
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The validity of the stages of change model in the adoption of the self-management approach in chronic pain.
Dijkstra A.
From the Department of Social and Organizational Psychology, University of Groningen, Groningen, The Netherlands.
In attempts to decrease chronic pain and the negative impact of chronic pain on broader functioning, patients can be stimulated to adopt self-management skills. However, not all patients are motivated to do so. Insight into the causes of motivation and the process of behavior change could increase the practitioners' effectiveness in stimulating patients to use self-management skills. The stages of change construct is a psychologic construct that maps the process of behavior change. Patients in the Precontemplation stage are not motivated to adopt self-management skills, patients in the Contemplation stage think about it, patients in the Preparation stage are planning to change and are already trying some (parts) of the skills, patients in the Action stage are actively learning to engage in self-management, whereas patients in the Maintenance stage keep on working to stabilize the new behavior pattern. Although the stages of change model is intuitively plausible and has the potential to increase effectiveness of the practitioners' counseling, its validity should be proven before it is applied clinically. The present article reviews the 8 available publications in which the stages of change construct is studied in patients with chronic pain. The results show that the theory of the stages of change needs more articulation, that the operationalization should be more directly derived from the theory, and that the results from more appropriate tests of the theory should be used to change the theory when necessary to develop it. Recommendations are made with regard to the theory, the operationalizations, and the tests to be conducted to develop the theory and assess its validity.
PMID: 15599129 [PubMed - in process]
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Treatment Expectancy Affects the Outcome of Cognitive-Behavioral Interventions in Chronic Pain.
Goossens ME, Vlaeyen JW, Hidding A, Kole-Snijders A, Evers SM.
From the *Department of Medical, Clinical, and Experimental Psychology, Maastricht University, Maastricht, The Netherlands; daggerInstitute for Rehabilitation Research, Hoensbroek, The Netherlands; double daggerPain Management and Research Center, University Hospital Maastricht, Maastricht, The Netherlands; section signRehabilitation Center Hoensbroeck, Hoensbroek, The Netherlands; and parallelDepartment of Health Organization Policy and Economics, Maastricht University, Maastricht, The Netherlands.
Patients' initial beliefs about the success of a given pain treatment are shown to have an important influence on the final treatment outcome. The aims of the paper are to assess determinants of patients' treatment expectancy and to examine the extent to which treatment expectancy predicts the short-term and long-term outcome of cognitive-behavioral treatment of chronic pain. This study employs the data of 2 pooled randomized clinical trials evaluating the effectiveness of cognitive-behavioral interventions for 171 patients with fibromyalgia and chronic low back pain. Pretreatment and posttreatment expectancy were measured by a short questionnaire, which was based on the procedure by Borkovec and Nau. Four composite outcome variables (pain coping and control, motoric behavior, negative affect, and quality of life) were measured before and after the intervention and at 12 months follow-up. Furthermore, several patient characteristics were taken into account. Patients with higher treatment expectancies significantly received less disability compensation and were less fearful. A regression model of 3 factors (better pain coping and control, active and positive interpretation of pain, and less disability compensation) significantly explained 10% of the variance in pretreatment expectancy. Pretreatment expectancy significantly predicted each of the 4 outcome measures immediately after treatment and at 12 months follow-up. This study corroborates the importance of treatment expectation before entering a cognitive-behavioral intervention in patients with chronic musculoskeletal pain.
PMID: 15599128 [PubMed - as supplied by publisher]
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Fear of Movement/(Re)injury in Chronic Low Back Pain: Education or Exposure In Vivo as Mediator to Fear Reduction?
de Jong JR, Vlaeyen JW, Onghena P, Goossens ME, Geilen M, Mulder H.
From the *Department of Rehabilitation, University Hospital Maastricht, Maastricht, The Netherlands; daggerDepartment of Medical Psychology, University Hospital Maastricht, Maastricht, The Netherlands; double daggerInstitute for Rehabilitation Research, Hoensbroek, The Netherlands; section signDepartment of Medical, Clinical, and Experimental Psychology, Maastricht University, Maastricht, The Netherlands; parallelPain Management and Research Center, University Hospital Maastricht, Maastricht, The Netherlands; paragraph signDepartment of Educational Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; and #Rehabilitation Center "Hoensbroeck," Hoensbroek, The Netherlands.
Clinical research of graded exposure in vivo with behavioral experiments in patients with chronic low back pain who reported fear of movement/(re)injury shows abrupt changes in self-reported pain-related fears and cognitions. The abrupt changes are more characteristics of insight learning rather than the usual gradual progression of trial and error learning. The educational session at the start of the exposure might have contributed to this insight. The current study examines the contribution of education and graded exposure versus graded activity in the reduction of pain-related fear and associated disability and physical activity. Six consecutive patients with chronic low back pain who reported substantial fear of movement/(re)injury were included in the study. After a no-treatment baseline measurement period, all the patients received a single educational session, followed again by a no-treatment period. Patients were then randomly assigned to either a graded exposure with behavioral experiments or an operant graded activity program. A diary was used to assess daily changes in pain intensity, pain-related fear, pain catastrophizing, and activity goal achievement. Standardized questionnaires of pain-related fear, pain vigilance, pain intensity, and pain disability were administered before and after each intervention and at the 6-month follow-up. An activity monitor was carried at baseline, during the interventions, and 1 week at 6-month follow-up. Randomization tests of the daily measures showed that improvements in pain-related fear and catastrophizing occurred after the education was introduced. The results also showed a further improvement when exposure in vivo followed the no-treatment period after the education and not during the operant graded activity program. Performance of relevant daily activities, however, were not affected by the educational session and improved significantly only in the exposure in vivo condition. All improvements remained at half-year follow-up only in patients receiving the exposure in vivo. These patients also reported a significant decrease in pain intensity at follow-up.
PMID: 15599127 [PubMed - as supplied by publisher]
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Cognitive-Behavioral Treatments for Chronic Pain: What Works for Whom?
Vlaeyen JW, Morley S.
From the *Department of Medical, Clinical, and Experimental Psychology, Maastricht University, Maastricht, The Netherlands; daggerPain Management and Research Center, University Hospital Maastricht, Maastricht, The Netherlands; double daggerInstitute for Rehabilitation Research, Hoensbroek, The Netherlands; and section signAcademic Unit of Psychiatry & Behavioural Sciences, University of Leeds, Leeds, United Kingdom.
Since the introduction of behavioral medicine in the early 70s, cognitive-behavioral treatment interventions for chronic pain have expanded considerably. It is now well established that these interventions are effective in reducing the enormous suffering that patients with chronic pain have to bear. In addition, these interventions have potential economic benefits in that they appear to be cost-effective as well. Despite these achievements, there is still room for improvement. First, there is a substantial proportion of patients who do not appear to benefit from treatment interventions available. Second, although the effect sizes of most cognitive-behavioral treatments for chronic pain are comparable to those in psychopathology, they are quite modest. Third, there is little evidence for differential outcomes for different treatment methods. Fourth, there still is relatively little known about the specific biobehavioral mechanisms that lead to chronic pain and pain disability. One direction is to better match treatment programs to patients' characteristics. This can be done according to an "Aptitude X Treatment Interaction" framework, or from the perspective of the Moderator-Mediator distinction. In this introduction to the special series on what works for whom in cognitive-behavioral treatments for chronic pain, we review existing knowledge concerning both moderating and mediating variables in cognitive-behavioral treatments for chronic pain. We further argue in favor of theory-driven research as the only way to define specific a priori hypotheses about which patient-treatment interactions to expect. We also argue that replicated single-participant studies, with appropriate statistics, are likely to enhance new developments in this clinical research area.
PMID: 15599126 [PubMed - as supplied by publisher]
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Pain control with low-dose alfentanil in children undergoing minor abdominal and genito-urinary surgery.
Leoni F, Benni F, Iacobucci T, de Francisci G.
Catholic University of Sacred Heart, Istituto di Anestesiologia e Rianimazione, Rome, Italy.
BACKGROUND AND OBJECTIVE: The aim of this study was to investigate the quality of intra- and postoperative analgesia obtained by alfentanil compared to that produced by peripheral blockade in children. METHODS: During sevoflurane-nitrous oxide atracurium anaesthesia for minor abdominal or genito-urinary surgery, three groups of children aged 0-8 yr received 25 microg kg(-1) alfentanil intravenously (n = 28), or peripheral nerve blockade using 1 mLkg(-1) ropivacaine 0.475% (n = 24), or 12.5 microg kg(-1) alfentanil intravenously with peripheral nerve blockade using 1 mL kg(-1) ropivacaine 0.475% (n = 30). Changes in blood pressure and heart rate were measured during the procedures. Postoperative pain was assessed using the face, legs, activity, cry, consolability (FLACC) observational tool for quantifying pain behaviour and a numerical scale scored by nurses, doctors, parents and children. RESULTS: There was no significant difference in intra- or postoperative analgesic efficacy among the three groups. Patients who received alfentanil had significantly lower heart rates than those who received nerve blockade only (96.0+/-15.6 vs. 115.9+/-23.2 beats min(-1), P < 0.001). FLACC and numerical scale scores did not differ among the groups. There were no significant differences in incidence of vomiting or use of pain medications. CONCLUSIONS: It was concluded that a low-dose, intravenous bolus of alfentanil may be an efficient alternative to peripheral nerve blockade in controlling pain during and after minor abdominal and genito-urinary surgery.
PMID: 15595588 [PubMed - in process]
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Continuous spinal analgesia or opioid-added continuous epidural analgesia for postoperative pain control after hip replacement.
Gurlit S, Reinhardt S, Mollmann M.
St Franziskus-Hospital, Department of Anaesthesiology and Intensive Care Medicine, Hohenzollernring, Munster, Germany.
BACKGROUND AND OBJECTIVE: Continuous spinal anaesthesia and continuous epidural anaesthesia are both able to provide adequate postoperative pain relief. Combining local anaesthetics and opioids results in synergistic effects. The purpose of this randomized, prospective study was to compare quality of analgesia, side-effects and patient's satisfaction between spinal bupivacaine alone and epidural bupivacaine with sufentanil postoperatively. METHODS: Fifty-nine patients scheduled for hip arthroplasty were randomly assigned either to Group 1 receiving continuous spinal anaesthesia or Group 2 receiving continuous epidural anaesthesia. Postoperatively, those in Group 1 received a 1 mL bolus followed by a continuous infusion of 10 mL/24 h of bupivacaine 0.25 %. Those in Group 2 received a 5 mL bolus of lidocaine 2%, followed by a continuous infusion of bupivacaine 0.25% with sufentanil 0.001 mg mL(-1) at 4 mL h(-1). Pain was measured using a verbal rating score and a visual analogue scale. RESULTS: Group 1 and Group 2 of 43.3% and 37.9% reported complete analgesia on the verbal rating score. No statistically significant difference was found in the visual analogue scale. Nausea and vomiting occurred significantly more often in Group 2. The patient satisfaction rates did not differ significantly. CONCLUSIONS: Continuous spinal analgesia with bupivacaine alone and continuous epidural analgesia with bupivacaine/sufentanil are both effective for postoperative pain relief after hip replacement. Those patients in the epidural group reported better analgesia but had a higher rate of postoperative nausea and vomiting. Efficacy of pain therapy did not correlate with patient satisfaction.
PMID: 15595583 [PubMed - in process]
Sex differences in opioid analgesia: clinical and experimental findings.
Fillingim RB, Gear RW.
Public Health Services and Research, College of Dentistry, University of Florida, 1600 SW Archer Road, Room D8-44A, P.O. Box 100404, Gainesville, FL 32610-0404, USA. rfillingim@dental.ufl.edu
Sex differences in analgesic responses to opioids have received increasing attention in recent years. This article examines the literature on sex differences in opioid analgesia, including the results of studies from the authors' own laboratories. In general, nonhuman animal studies suggest more robust opioid analgesic responses in males relative to females; however, the human studies completed to date seem to indicate greater opioid analgesia among females. The most consistent evidence of sex differences in analgesia comes from studies of kappa-agonist-antagonists administered to patients following oral surgery. These data indicate more robust analgesia in females, and dose-response characteristics suggest that these agents possess both analgesic and antianalgesic properties, and the agonists may produce these effects in different proportions for women versus men. In contrast, the data from laboratory pain models in humans suggest greater analgesic effects in women in response mu-opioid agonists but not kappa-agonist-antagonists. Multiple mechanisms may explain sex differences in opioid analgesia, including gonadal hormonal effects, pharmacokinetics and pharmacodynamics, genetic influences, balance of analgesic/antianalgesic processes, and psychological factors. However, the disparity of results obtained from different pain models--animals versus humans and clinical pain versus experimental pain in humans--suggests that the models themselves are mechanistically different. Additional investigation is warranted in order to further explicate the nature of sex differences in opioid analgesia and to elucidate the underlying mechanisms.
Publication Types:
PMID: 15324773 [PubMed - indexed for MEDLINE]
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Pharmacological profile of parecoxib: a novel, potent injectable selective cyclooxygenase-2 inhibitor.
Padi SS, Jain NK, Singh S, Kulkarni SK.
Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India.
The antinociceptive, anti-inflammatory, antipyretic effects along with gastric safety profile of parecoxib, a novel, potent selective cyclooxygenase-2 inhibiting prodrug, and those of ketorolac, a nonselective cyclooxygenase inhibitor, were evaluated in various animal models. Parecoxib (up to 20 mg/kg, i.v.) had no effect in two acute pain models, namely, the acetic acid-induced writhing (visceral pain) and the formalin test (tonic pain). However, ketorolac (up to 10 mg/kg, i.v.) showed marked antinociceptive effects in these models. In the models of carrageenan-provoked inflammatory hyperalgesia and inflammation, and in lipopolysaccharide-induced pyrexia, parecoxib significantly reversed all the behavioral changes and it was found to be more potent than ketorolac. Further, ketorolac (10 mg/kg, i.v.) produced visible gastric lesions with prominent petechiae and hemorrhagic streaks. However, parecoxib was without any effect on gastric mucosa. The present results showed that the cyclooxygenase-2 inhibitor, parecoxib, when administered parenterally, has potent antihyperalgesic, anti-inflammatory, antipyretic effects and has a better safety profile than with ketorolac, with sparing of cyclooxygenase-1 in the stomach in these animal models.
PMID: 15102535 [PubMed - indexed for MEDLINE]
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Involvement of spinal lipoxygenase metabolites in hyperalgesia and opioid tolerance.
Trang T, McNaull B, Quirion R, Jhamandas K.
Department of Pharmacology and Toxicology, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada, K7L 3N6.
This study investigated role of spinal lipoxygenase metabolites in induction of hyperalgesia and development of opioid analgesic tolerance. In the rat, nociception was measured using formalin and tail-flick tests. Intrathecal administration of leukotriene receptor agonist (LTB4) augmented the second phase of the formalin response and marginally increased sensitivity to acute thermal stimulation in the tail-flick test, responses suppressed by 6-(6-(3R-hydroxy-1E,5Z-undecadien-1-yl)-2-pyridinyl)-1,5S-hexanediol (U75302), a leukotriene BLT receptor antagonist. Treatment with 15-hydroxyperoxyeicosatetranoic acid (HPETE) increased phase II formalin activity, but had no effect on tail-flick responses. 12-HPETE failed to produce an effect in either nociceptive test. In the second part of this study, chronic spinal morphine for 5 days produced progressive decline in morphine antinociception and loss in analgesic potency. These effects were attenuated by co-administration of morphine with selective and nonselective lipoxygenase inhibitors. These results suggest involvement of lipoxygenase metabolites in both pain modulation and induction of opioid tolerance at the spinal level.
PMID: 15102529 [PubMed - indexed for MEDLINE]
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Pharmacological characterisation of acid-induced muscle allodynia in rats.
Nielsen AN, Mathiesen C, Blackburn-Munro G.
Department of Pharmacology, NeuroSearch A/S, Pederstrupvej 93, DK-2750 Ballerup, Denmark. ann@neurosearch.dk
Previous studies have shown that repeated injections of acidic saline, given into the lateral gastrocnemius muscle of rats, results in a bilateral reduction in withdrawal threshold to tactile stimulation of the hindpaws. We have now characterised this model of muscoskeletal pain pharmacologically, by evaluating the antinociceptive effects of various analgesics after systemic administration. The micro-opioid receptor agonist morphine (3 and 6 mg/kg) produced a particularly prolonged antiallodynic effect. The glutamate receptor antagonists ([8-methyl-5-(4-(N,N-dimethylsulfamoyl)phenyl)-6,7,8,9,-tetrahydro-1H-pyrrolo[3,2-h]-iso-quinoline-2,3-dione-3-O-(4-hydroxybutyric acid-2-yl)oxime] NS1209 and ketamine (6 and 15 mg/kg, respectively), the KCNQ K(+) channel openers retigabine and flupirtine (10 and 20 mg/kg, respectively) and the Na(+) channel blocker mexiletine (37.5 mg/kg) also significantly increased paw withdrawal threshold, although to a lesser degree than morphine. In contrast, the anticonvulsant lamotrigine (30 mg/kg), the cyclooxygenase-2 inhibitor carprofen (15 mg/kg) and the benzodiazepine diazepam (3 mg/kg) were ineffective. All antinociceptive effects were observed at nonataxic doses as determined by the rotarod test. These results suggest that in this model, muscle-mediated pain can be alleviated by various analgesics with differing mechanisms of action, and that once established ongoing inflammation does not appear to contribute to this process.
PMID: 15033380 [PubMed - indexed for MEDLINE]
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Characterization of the early pharmacodynamic profile of oral methadone for cancer-related breakthrough pain: a pilot study.
Fisher K, Stiles C, Hagen NA.
Alberta Cancer Board Palliative Research Initiative (K.F., C.S., N.A.H.); Department of Obstetrics and Gynecology (K.F.), Division of Palliative Medicine (N.A.H.), and Departments of Oncology, Clinical Neurosciences, and Medicine (N.A.H.), University of Calgary; and Tom Baker Cancer Center, Calgary, Canada.
Methadone is effective for chronic cancer pain, but its early pharmacodynamic profile and effectiveness for breakthrough pain remain uncertain. This was an open-label, non-randomized, crossover study comparing the use of oral methadone for breakthrough pain with patients' usual opioid. Study variables included pain intensity (pretreatment and at 10-minute intervals post treatment), treatment-related side effects, and treatment satisfaction. In 37 discrete episodes of breakthrough pain, onset of analgesic effect of a titrated dose of oral methadone was rapid for all patients; 3 of 6 study patients experienced an onset of relief by 10 minutes post-ingestion. The adverse effect profile of oral methadone was not different from patients' usual 'rescue' opioid, and patients were moderately to completely satisfied with oral methadone as a breakthrough pain medication. These observations suggest that oral methadone can have a rapid onset of analgesic action and may have a legitimate role in the management of cancer-related breakthrough pain.
PMID: 15589088 [PubMed - as supplied by publisher]
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Stability of clonidine in clonidine-hydromorphone mixture from implanted intrathecal infusion pumps in chronic pain patients.
Rudich Z, Peng P, Dunn E, McCartney C.
Department of Anesthesiology (Z.R.) and Wasser Pain Management Center (Z.R., P.P., C.M.), Mount Sinai Hospital, University of Toronto, Toronto; Department of Anesthesiology (P.P., C.M.), Toronto Western Hospital, University of Toronto, Toronto; and Department of Psychiatry (E.D.), Psychopharmacology Research Laboratory, Center for Addiction and Mental Health, Toronto, Ontario, Canada.
Clonidine is frequently added to opioids in implantable intrathecal pumps for the management of chronic pain. In such devices, a small non-retrievable volume is always present in the reservoir, and its effect on drug stability is unknown. Furthermore, stability of clonidine, when mixed with hydromorphone, has not been previously determined. This study examined the stability of clonidine when co-administered with hydromorphone in implanted intrathecal pumps. Samples of hydromorphone-clonidine before pump refill and from residual solution at subsequent refill were obtained from chronic pain patients. Clonidine concentration was measured using HPLC. Twenty paired samples from 3 patients were analyzed. All 3 patients had a SynchroMed pump implanted for 3-5 years. We found no loss in clonidine concentration during the time between refills (35 +/- 13 days), and no correlation between clonidine concentration and time interval between refills. In conclusion, clonidine, mixed with hydromorphone, is stable when delivered by implantable intrathecal pump for long-term use.
PMID: 15589085 [PubMed - as supplied by publisher]
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Pain in community-dwelling persons with dementia: frequency, intensity, and congruence between patient and caregiver report.
Shega JW, Hougham GW, Stocking CB, Cox-Hayley D, Sachs GA.
Section of Geriatrics (J.W.S., G.W.H., C.B.S., D.C.-H., G.A.S.), Department of Medicine; and MacLean Center for Clinical Medical Ethics (C.B.S.), The University of Chicago, Chicago, Illinois, USA.
To better understand the pain experience of persons with dementia and to describe what factors are related to congruence of pain reports within patient-caregiver dyads, a cohort study enrolled patient-caregiver dyads at a primary care geriatrics clinic. Thirty-two percent of persons with dementia self-report pain "right now." Of these, 65% report slight/mild pain, 27% moderate pain, and 8% severe pain or greater. Fifty-two percent of caregivers report their care recipients with dementia are in some pain "right now." Of these, 52% report slight/mild pain, 30% moderate, and 18% severe pain or greater. Fifty-nine percent of dyads agree on the presence or absence of patient pain. In multivariate analysis of dyadic congruence of pain reports by patient and caregiver factors, only patient factors predicted congruence. The odds of congruence of pain reports increase 3.7 (1.2-12.3) if the patient is male and decrease 0.938 (0.93-0.99) as the patient becomes more agitated. These findings suggest that community-dwelling persons with dementia report less pain than those in the nursing home and caregivers do a fair job of predicting patient pain.
PMID: 15589083 [PubMed - in process]
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Pain prevalence, experiences and management strategies among the elderly in taiwanese nursing homes.
Tsai YF, Tsai HH, Lai YH, Chu TL.
School of Nursing (Y.-F.T., H.-H.T.), Chang Gung University, Tao-Yuan, Taiwan; College of Nursing (Y.-H.L.), Taipei Medical University, Taipei, Taiwan; and Department of Nursing (T.-L.C.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan.
The purpose of this study was to explore pain prevalence, experiences, and self-care management strategies among elderly residents of nursing homes in Taiwan. Stratified random sampling was used to recruit participants (n=150). In these elderly nursing home residents, pain prevalence was 65.3% and the average number of pain sites was 3.24 (SD=2.59). The mean pain intensity was 3.86 (SD=1.90) and pain interference was 4.30 (SD=2.28). "Aching" was the word most commonly used (77.6%) to describe pain. Most participants (54.21%) took prescribed medications for dealing with pain; doctors were the main information source for this self-care strategy. Although participants reported severe bouts of pain, they used limited self-care pain management strategies. Since health care providers play an important role in helping the elderly to manage pain, the authors recommend training nursing home staff to perform regular pain assessments and providing current knowledge about pain assessment and management strategies.
PMID: 15589082 [PubMed - in process]
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Cancer patient and caregiver experiences: communication and pain management issues.
Kimberlin C, Brushwood D, Allen W, Radson E, Wilson D.
Department of Pharmacy Health Care Administration (C.K., D.B., D.W.), College of Medicine (W.A.), Shands Hospital Anesthesiology Pain Service (E.R.), University of Florida, Gainesville, Florida, USA.
This study examined facilitators and barriers to effective patient and caregiver communication with providers with emphasis on communication related to cancer pain management. Focus groups and personal interviews were conducted with cancer patients and family caregivers of patients. Communication experiences of subjects as well as suggestions for ways to improve the communication process were elicited. Twenty-two cancer patients and 16 family caregivers participated in the study. Seven themes emerged suggesting improvements that are needed in the communication process. These include: 1) improving the process of information exchange, 2) increasing active participation of patient and caregiver in the care process, 3) improving provider relationship-building skills, 4) overcoming time barriers, 5) addressing fears regarding use of pain management medications, 6) fostering appropriate involvement of family and caregivers in the communication process, and 7) improving coordination of care among providers. Specific suggestions and their practice implications for health care providers are highlighted.
PMID: 15589081 [PubMed - in process]
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Diamorphine-Intrasite dressings for painful pressure ulcers.
Abbas SQ.
St. Clare Hospice Hastingwood, Essex, United Kingdom.
Publication Types:
PMID: 15589076 [PubMed - in process]
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Treatment of postherpetic neuralgia: a review of therapeutic options.
Argoff CE, Katz N, Backonja M.
Cohn Pain Management Center, North Shore University Hospital, Cohn Pain Management Center, Bethpage, New York 11714, USA.
Postherpetic neuralgia (PHN) is a disabling consequence of the reactivation of the varicella zoster infection. The observation that patients with PHN experience various types of pain suggests that multiple pathophysiologic mechanisms are involved, which may include the peripheral and central nervous systems. A reasonable initial strategy would involve selecting from among multiple agents that have complementary mechanisms of action and that have been proven effective in controlled clinical trials, such as the lidocaine patch 5%, gabapentin, tricyclic antidepressants, and opioids. Based on initial assessment and ongoing reassessment, sequential trials should be undertaken until adequate pain relief is achieved. This may ultimately lead to therapy with more than one medication. Safety and tolerability are important considerations in choosing initial therapy, particularly in older patients. Physicians can either add another agent to the current regimen or switch to a new type of monotherapy if there is inadequate response to initial therapy. Alternative therapies, (i.e., ketamine, intrathecal corticosteroid injections) have not been adequately studied. Well-designed, multicenter, controlled clinical trials are needed to develop a treatment algorithm that provides an evidence-based, rational approach to treating PHN.
Publication Types:
PMID: 15471658 [PubMed - indexed for MEDLINE]
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Towards a new clinical tool for needs assessment in the palliative care of cancer patients: the PNPC instrument.
Osse BH, Vernooij MJ, Schade E, Grol RP.
Center of Quality of Care Research, University of Nijmegen, The Netherlands.
This study describes a new clinical tool for needs assessment in palliative care: the Problems and Needs in Palliative Care questionnaire (PNPC). It was developed to support the provision of care tailored to the specific demands of patients, which only can be provided when their needs are clearly identified. To test validity and reliability, 64 patients with metastatic cancer living at home completed the PNPC. Of 140 initial items, 2 were deleted because of low response. No important topics were missing. Dimensions were proposed to organize the problems and needs in a logical and practical array for use in individual patients, and to enable statistical analysis of patient-groups. Reliability analysis supported the proposed dimensions, with Cronbach's alpha coefficient >0.70 for dimensions with > or = 5 items, and alpha >0.65 for the 3- and 4-item dimensions. However, the dimensions 'physical symptoms' and 'social issues' lacked coherency with some low item-total correlations. The PNPC demonstrated convergent validity with the European Organization for Research and Treatment of Cancer (EORTC) and COOP-WONCA quality-of-life measures. These data are a first step in validating the PNPC, although the 'social issues' dimension needs reconsideration. Further studies are needed to evaluate clinical use.
Publication Types:
- Clinical Trial
- Validation Studies
PMID: 15471650 [PubMed - indexed for MEDLINE]
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The management of malignant psoas syndrome: case reports and literature review.
Agar M, Broadbent A, Chye R.
Sacred Heart Palliative Care Service, St. Vincents Hospital, Darlinghurst, Sydney, Australia.
Malignant psoas syndrome (MPS) was first described in 1990, and is characterized by proximal lumbosacral plexopathy, painful fixed flexion of the ipsilateral hip, and radiological or pathological evidence of ipsilateral psoas major muscle malignant involvement. There have been 23 case reports of MPS in medical journals. Despite being associated with a severe and difficult pain, there is no definitive approach to management presented in the palliative care literature. We review the relevant clinical features and the subsequent multidisciplinary pain management in relation to four new cases of malignant involvement of the psoas muscle, and the 23 case reports in the literature. We propose that MPS comprises a continuum of symptoms and signs related to the degree of anatomical destruction with associated inflammatory reaction and muscle spasm, and also the degree of lumbosacral plexopathy causing neuropathic pain. A protocol is presented for the management of the complex pain issues of MPS directed at likely mechanisms. The treatment options include opioids, agents for neuropathic pain, muscle relaxants to manage psoas muscle spasm, and anti-inflammatory agents to reduce peritumoral edema. Direct anti-tumor measures also need to be considered. Further prospective study is needed to validate the proposed methods of assessment and treatment.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15336342 [PubMed - indexed for MEDLINE]
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Massage therapy for symptom control: outcome study at a major cancer center.
Cassileth BR, Vickers AJ.
Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Massage is increasingly applied to relieve symptoms in patients with cancer. This practice is supported by evidence from small randomized trials. No study has examined massage therapy outcome in a large group of patients. At Memorial Sloan-Kettering Cancer Center, patients report symptom severity pre- and post-massage therapy using 0-10 rating scales of pain, fatigue, stress/anxiety, nausea, depression and "other." Changes in symptom scores and the modifying effects of patient status (in- or outpatient) and type of massage were analyzed. Over a three-year period, 1,290 patients were treated. Symptom scores were reduced by approximately 50%, even for patients reporting high baseline scores. Outpatients improved about 10% more than inpatients. Benefits persisted, with outpatients experiencing no return toward baseline scores throughout the duration of 48-hour follow-up. These data indicate that massage therapy is associated with substantive improvement in cancer patients' symptom scores.
PMID: 15336336 [PubMed - indexed for MEDLINE]
Comment on:
Re: systematic review of long-acting oral opioids.
Manchikanti L, Boswell MV, Atluri S.
Publication Types:
PMID: 15336326 [PubMed - indexed for MEDLINE]
A 69-year-old woman with left main coronary artery disease.
Carrozza JP Jr, Sellke FW.
Harvard Medical School, Boston, Mass, USA. jcarrozz@bidmc.harvard.edu
Publication Types:
- Case Reports
- Clinical Conference
PMID: 15562131 [PubMed - indexed for MEDLINE]
Pregabalin relieves symptoms of painful diabetic neuropathy: a randomized controlled trial.
Lesser H, Sharma U, LaMoreaux L, Poole RM.
University of Rochester School of Medicine & Dentistry, Rochester, NY, USA. Harold.Lesser@viahealth.org
OBJECTIVE: Pregabalin, an alpha2-delta ligand with analgesic, anxiolytic, and anticonvulsant activity, has been evaluated for treatment of neuropathic pain. The authors assessed the efficacy and tolerability of pregabalin (75, 300, 600 mg/day) vs placebo in patients with diabetic peripheral neuropathy (DPN). METHODS: Patients with a 1- to 5-year history of DPN and average weekly pain score of > or =4 on an 11-point numeric pain-rating scale were enrolled in a 5-week, double-blind, multicenter, placebo-controlled study. Patients (n = 338) were randomized to receive one of three doses of pregabalin or placebo TID. Pregabalin 600 mg/day was titrated over 6 days; lower doses were initiated on day 1. RESULTS: Patients in the 300- and 600-mg/day pregabalin groups showed improvements in endpoint mean pain score (primary efficacy measure) vs placebo (p = 0.0001). Improvements were also seen in weekly pain score, sleep interference score, patient global impression of change, clinical global impression of change, SF-McGill Pain Questionnaire, and multiple domains of the SF-36 Health Survey. Improvements in pain and sleep were seen as early as week 1 and were sustained throughout the 5 weeks. Responders (patients with > or =50% reduction in pain compared to baseline) were 46% (300 mg/day), 48% (600 mg/day), and 18% (placebo). Pregabalin was well tolerated with a low discontinuation rate. The most common adverse events were dizziness and somnolence. CONCLUSIONS: In patients with diabetic peripheral neuropathy, pregabalin demonstrated early and sustained improvement in pain and a beneficial effect on sleep, which were confirmed by positive patient global impression. Pregabalin was well tolerated at all doses.
PMID: 15596757 [PubMed - in process]
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Analgesia following surgery in children with and without cognitive impairment.
Koh JL, Fanurik D, Harrison RD, Schmitz ML, Norvell D.
Department of Anesthesiology and Perioperative Medicine, Department of Pediatrics, Oregon Health and Science University, Doernbecher Children's Hospital, 3181 SW Sam Jackson Park Rd, Mailcode UHS2, Portland, OR 97239, USA. kohj@ohsu.edu
Both children and adults with cognitive impairment (CI) have historically been excluded from research examining pain. This is unfortunate since patients with CI may be at higher risk for experiencing pain or having their pain undertreated due to the difficulty of pain assessment and communication. There are now several published reports about the general pain experience of both adult and pediatric patients with cognitive impairment. The purpose of this study was to compare the amount and type of pain medication administered in children with and without CI after surgery to ascertain if there were any differences in analgesic administration patterns between these two groups. One hundred and fifty-two children with borderline to profound CI and 138 non impaired (NI) children were recruited to participate. Analgesic administration data include type and amount of opioid, type of non-opioid medication, and prescribed discharge medications. Results of this study show that children with CI undergoing surgery received less opioid in the perioperative period than children without CI. However, children with CI received comparable amounts and types of analgesics in the postoperative period as children without CI.
PMID: 15363866 [PubMed - indexed for MEDLINE]
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